Abstract
Introduction: Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most frequent causes of adverse drug reactions, particularly in patients with asthma and chronic idiophatic urticaria. Many subjects report cutaneous and/or respiratory symptoms and, less frequently, anaphylactic shock after the administration of one (single-reactors) or different (cross-reactors) drugs of this class. Diagnosis: There are no reliable cutaneous or in vitro tests which allow NSAID hypersensitivity to be identified in patients with cross-reactive reactions; therefore, the challenge test is considered the “gold standard” for establishing or excluding a diagnosis of NSAID hypersensitivity in such patients. Management: Culprit drugs should always be avoided by patients with suspected or well-established multiple hypersensitivity to NSAIDs. The therapeutic options range from the administration of alternative drugs – such as weak cyclooxygenase (COX)-1 inhibitors and/or preferential or highly selective COX-2 inhibitors to desensitization to the culprit ones. Conclusion: In patients with different NSAID-induced reactions, the challenge test with both culprit drugs and alternative ones is the only method to establish a reliable diagnosis of NSAID hypersensitivity and to find some alternative therapeutic options, respectively. In specific cases, drug desensitization can also be performed. However, further studies are required to improve management of such patients.
Keywords: Nonsteroidal anti-inflammatory drugs, cross-reactivity, hypersensitivity, challenge test, desensitization
Current Pharmaceutical Design
Title: Cross-Reactive Reactions to Nonsteroidal Anti-Inflammatory Drugs
Volume: 14 Issue: 27
Author(s): Marinella Viola, Donato Quaratino, Francesco Gaeta, Gabriele Rumi, Cristiano Caruso and Antonino Romano
Affiliation:
Keywords: Nonsteroidal anti-inflammatory drugs, cross-reactivity, hypersensitivity, challenge test, desensitization
Abstract: Introduction: Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most frequent causes of adverse drug reactions, particularly in patients with asthma and chronic idiophatic urticaria. Many subjects report cutaneous and/or respiratory symptoms and, less frequently, anaphylactic shock after the administration of one (single-reactors) or different (cross-reactors) drugs of this class. Diagnosis: There are no reliable cutaneous or in vitro tests which allow NSAID hypersensitivity to be identified in patients with cross-reactive reactions; therefore, the challenge test is considered the “gold standard” for establishing or excluding a diagnosis of NSAID hypersensitivity in such patients. Management: Culprit drugs should always be avoided by patients with suspected or well-established multiple hypersensitivity to NSAIDs. The therapeutic options range from the administration of alternative drugs – such as weak cyclooxygenase (COX)-1 inhibitors and/or preferential or highly selective COX-2 inhibitors to desensitization to the culprit ones. Conclusion: In patients with different NSAID-induced reactions, the challenge test with both culprit drugs and alternative ones is the only method to establish a reliable diagnosis of NSAID hypersensitivity and to find some alternative therapeutic options, respectively. In specific cases, drug desensitization can also be performed. However, further studies are required to improve management of such patients.
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Cite this article as:
Viola Marinella, Quaratino Donato, Gaeta Francesco, Rumi Gabriele, Caruso Cristiano and Romano Antonino, Cross-Reactive Reactions to Nonsteroidal Anti-Inflammatory Drugs, Current Pharmaceutical Design 2008; 14 (27) . https://dx.doi.org/10.2174/138161208786369740
DOI https://dx.doi.org/10.2174/138161208786369740 |
Print ISSN 1381-6128 |
Publisher Name Bentham Science Publisher |
Online ISSN 1873-4286 |
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